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The Challenges and Prospects in Cochlear Implantation

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Otolaryngology".

Deadline for manuscript submissions: closed (30 September 2025) | Viewed by 14503

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Special Issue Editors

Dr. María Amparo Callejón Leblic

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Guest Editor

1. Biomedical Engineering Group, University of Seville, 41004 Seville, Spain
2. Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital, 41009 Seville, Spain
3. Oticon Medical, 28108 Madrid, Spain
Interests: bioelectrical modelling; computational audiology; hearing neuroscience; cochlear implants
Special Issues, Collections and Topics in MDPI journals

Dr. Angel Ramos de Miguel

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Guest Editor

Hearing and Balance Laboratory, University of Las Palmas de Gran Canaria, 35001 Las Palmas, Spain
Interests: cochlear implants; vestibular implants; intraoperative measurements; electrocochleography; transimpedance
Special Issues, Collections and Topics in MDPI journals

Dr. Joaquin Tomas Valderrama Valenzuela

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Guest Editor

1. Department of Signal Theory, Telematics and Communications, University of Granada, 18071 Granada, Spain
2. Research Centre for Information and Communication Technologies, University of Granada, 18071 Granada, Spain
3. Department of Linguistics, Macquarie University, Sydney, NSW 2109，Australia
Interests: signal processing; auditory evoked potentials; hearing neuroscience; cognition; Listening effort; cochlear implants
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Cochlear implants (CIs) constitute a paradigmatic example of the symbiosis between the fields of medicine and engineering. They have revolutionized hearing loss treatment by becoming more widespread and available to a greater number of patients with ever-increasing heterogeneous conditions, leading to an improvement in their quality of life and social integration. Nevertheless, despite the widespread use and technical improvement of CI devices over recent decades, scientific, clinical, and technical challenges do remain. For instance, the high inter-subject variability and the lack of sensitive biomarkers make the prediction of individual CI outcomes unreliable, and the optimal fitting of stimulation parameters challenging. Recent evidence has also uncovered the impact of hearing loss on cognition and vice versa, thus highlighting its complexity and the outstanding need for creating multimodal hearing datasets across different health domains. Therefore, interdisciplinary approaches in medicine, physiology, biology, neuroscience, data science, and engineering are essential to better delineate the main variables responsible for successful CI rehabilitation. This Special Issue invites interdisciplinary research groups to explore future challenges and prospects in CI implantation through original research articles focusing on—but not limited to—the following:

Cochlear implant candidacy, update on indications, and health-related issues;
Challenges in pediatric CI surgery and rehabilitation;
CI in the elderly;
New robotic and surgical CI procedures;
Personalized image-based anatomical modelling and fitting;
Electrophysiological and objective CI measures;
Advances in hardware and software and sound coding strategies;
In-noise speech intelligibility, sound localization, music assessment in CI users;
Listening/cognitive effort and fatigue in CI users;
Tinnitus management and CI;
Vestibular disorders and CI;
Ecological momentary assessment (EMA) in CI population;
Big data, AI and data-based computational approaches to improve CI devices and rehabilitation;
Analysis and research of special (unmet) needs in CI patients, family, caregivers, clinical professionals and other stakeholders;
Cochlear implantation in low- and middle-income countries.

This Special Issue welcomes different types of articles, including Original Research, Reviews, Communications, Opinions, Perspectives, Hypotheses, Technical Notes, and more. Article types accepted by MDPI can be found at https://www.mdpi.com/about/article_types.

You may choose our Joint Special Issue in Technologies.

Dr. María Amparo Callejón Leblic
Dr. Angel Ramos de Miguel
Dr. Joaquin Tomas Valderrama Valenzuela
Guest Editors

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Keywords

cochlear implant
hearing loss
image
modeling
cognition
electrophysiology
AI
big data
interdisciplinary assessment

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Published Papers (11 papers)

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16 pages, 2557 KB

Open AccessArticle

Cochlear Implantation in Children with Inner Ear Malformations: Auditory Outcomes, Safety and the Role of Anatomical Severity

by Miriam González-García, Cristina Alonso-González, Francisco Ropero-Romero, Estefanía Berrocal-Postigo, Francisco Javier Aguilar-Vera, Concepción Gago-Torres, Leyre Andrés-Ustárroz, Manuel Lazo-Maestre, M. Amparo Callejón-Leblic and Serafín Sánchez-Gómez

J. Clin. Med. 2025, 14(22), 8245; https://doi.org/10.3390/jcm14228245 - 20 Nov 2025

Viewed by 495

Abstract

Background/Objectives: Cochlear implantation (CI) has been shown to be effective in children with inner ear malformations (IEMs). However, outcomes vary with malformation type and anatomical complexity. Advances in radiological classification may improve the understanding of such variability to better guide patient counseling. We aimed to assess one-year post-implant auditory outcomes in children with IEMs using radiology-based classifications, and to explore genetic and perinatal predictors. We also propose a preliminary severity score derived from the INCAV system. Methods: Out of 303 pediatric CI recipients assessed at a tertiary center, we retrospectively analyzed 41 children (82 ears) diagnosed with IEMs. Malformations were categorized with the Sennaroğlu system and re-coded using INCAV, from which a severity score was derived. Postoperative outcomes were assessed in 56 implanted ears, including pure-tone average (PTA), word recognition score (WRS), and post-surgical complications. Statistical analyses included Spearman’s correlation, linear regression, and exploratory discriminant MANOVA. Results: The most frequent malformation was enlarged vestibular aqueduct (33%), followed by incomplete partition type II (22%). CI was performed in 56 malformed ears with a complication rate of 10.7%. PTA and WRS correlated with the INCAV-derived severity score, with higher severity linked to poorer thresholds and lower WRS. Linear regression showed severity explained ~20% of PTA variance, with outcomes more frequently impaired in ears with scores > 3. Exploratory analysis revealed inter-subject variability, with partial separation of mild versus moderate/severe groups mainly driven by PTA and WRS. Conclusions: CI in pediatric IEMs is safe and consistently improves hearing thresholds. PTA was the most robust predictor of performance, while the INCAV-derived severity score, though exploratory, may provide additional value for anatomical stratification, prognostic counseling, and rehabilitation planning. Full article

(This article belongs to the Special Issue The Challenges and Prospects in Cochlear Implantation)

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21 pages, 1468 KB

Open AccessArticle

Changes in Speech Intelligibility, Health-Related Quality of Life, Depressive Symptoms, Anxiety, Perceived Stress, and Tinnitus-Induced Distress, in a Cohort of 227 Adults One Year After Cochlear Implantation: A Decade of Experience from a Single Tertiary Center

by Heidi Olze, Moritz Gröschel and Agnieszka J. Szczepek

J. Clin. Med. 2025, 14(22), 8143; https://doi.org/10.3390/jcm14228143 - 17 Nov 2025

Viewed by 350

Abstract

Background/Objectives: The purpose of this study was to analyze changes in speech intelligibility, health-related quality of life, and the degree of comorbidities (depressive and anxiety symptoms and tinnitus-related distress) in a large cohort of 227 adults who underwent auditory rehabilitation with a cochlear implant (CI). The second goal was to identify the factors that influence the health-related quality of life in this cohort. Methods: Pre- and one-year post-CI data were collected on speech intelligibility (Freiburg Monosyllabic Test, FS), subjective hearing ability (Oldenburg Inventory, OI), health-related quality of life (Nijmegen Cochlear Implant Questionnaire, NCIQ), depressive symptoms (General Depression Scale, ADS-L), anxiety (Generalized Anxiety Disorder 7, GAD-7), perceived stress (Perceived Stress Questionnaire, PSQ), and tinnitus-related distress (Tinnitus Questionnaire, TQ). Results: The Wilcoxon matched-pairs signed-rank test showed significant improvements across the entire cohort in speech intelligibility, subjective hearing, and the quality of life. The scores indicating anxiety, depressiveness, perceived stress, and tinnitus-related distress decreased. The Spearman correlation showed that before implantation, quality of life positively related to subjective hearing, while depression, anxiety, stress, and tinnitus distress were negatively correlated. After a year, these links persisted but grew stronger. Regression analyses found subjective hearing (OI) as a positive predictor, and depression (ADS-L) and tinnitus distress (TQ) as negative predictors of life quality, especially in patients with low or median NCIQ scores. Conclusions: In a substantial cohort of adult patients with diverse CI indications, auditory rehabilitation enhances speech intelligibility and subjective hearing, improves health-related quality of life, and reduces the severity of depressive and anxiety symptoms, as well as tinnitus-related distress. Subjective hearing contributes positively to quality of life, whereas depressive symptoms and tinnitus distress negatively impact quality of life in patients with low NCIQ scores post-CI, highlighting the importance of monitoring and psychological intervention. Full article

(This article belongs to the Special Issue The Challenges and Prospects in Cochlear Implantation)

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24 pages, 1245 KB

Open AccessArticle

What to Measure? Development of a Core Outcome Set to Assess Remote Technologies for Cochlear Implant Users

by Catherine Sucher, David Allen, Emma Laird, Isabelle Boisvert and Melanie Ferguson

J. Clin. Med. 2025, 14(21), 7697; https://doi.org/10.3390/jcm14217697 - 30 Oct 2025

Viewed by 635

Abstract

Background/Objectives: Uptake of remote cochlear implant (CI) services is feasible in clinical studies, but implementation into regular clinical practice is limited. Effective implementation requires demonstration of at least equivalent outcomes to in-person care. Use of outcome measures (e.g., specific tools such as speech tests or surveys) that are relevant and sensitive to both modes of service facilitates evidence-based provision of CI services. Following our previous study, which developed a core outcome domain set (CODS) (i.e., a set of CI outcome areas important to measure), this study aimed to (1) review current awareness and use of outcome measures implemented clinically, in-person, or remotely; and (2) provide recommendations for a pragmatic core outcome set (COS) to assess remote technologies for CI users. Methods: Expert Australian/New Zealand clinical CI professionals (n = 20) completed an online survey regarding use of, and familiarity with, pre-identified outcome measures mapping to the previously identified CODS. Respondents rated the outcomes’ usefulness, ease of use, trustworthiness, and recommendation for future use. Stakeholder workshops (clinician, n = 3, CI users n = 4) finalised recommendations. Results: Four of the six most regularly used and familiar measures were speech perception tests: BKB-A sentences, CNC words, CUNY sentences, and AB words. The long- and short-form Speech, Spatial, and Qualities of Hearing Scales (SSQ/SSQ-12) were the top-ranked patient-reported outcome measures (PROMs). These outcome measures were also perceived as the most trustworthy, easy to use, and likely to be used if recommended. Conclusions: A pragmatic COS, relevant to both remote and in-person delivery of CI services, including recommendations for measurement of service, clinician-measured and patient-reported outcomes, and how these might be developed in future, is recommended. Full article

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11 pages, 245 KB

Open AccessFeature PaperArticle

When Do We Use Alternative Methods? Examination of the Factors Affecting the Use of Alternative Methods in Cochlear Implantation Surgery

by Enver Can Öncül, Yüksel Olgun, Can Apaydın, Özden Savaş, Erdoğan Özgür, Enes Bilgin Türkmenoğlu and Enis Alpin Güneri

J. Clin. Med. 2025, 14(18), 6525; https://doi.org/10.3390/jcm14186525 - 17 Sep 2025

Viewed by 633

Abstract

Background/Objectives: This study aimed to evaluate factors necessitating alternative techniques during cochlear implant (CI) surgery and to compare outcomes with standard procedures. Methods: Patients of all ages who underwent CI at our center between January 2003 and January 2024 were included. Alternative methods were defined as removal of external auditory canal/posterior canal wall, removal of ossicles to enhance surgical view, use of an endoscope for round window visualization, or similar approaches. Results: A total of 404 patients (mean age 13 ± 19.7 years) were analyzed. Preoperative imaging revealed inner ear anomalies in 44 patients (10.9%). Alternative methods were used in 41 patients (10.1%), including incus removal (n = 16), endoscopic assistance (n = 14), posterior canal wall removal (n = 4), incus buttress removal (n = 3), combined ossicle removal (n = 3), and one canal wall down mastoidectomy with fat graft obliteration and blind pouch closure. Alternative methods were significantly more frequent in patients with inner ear anomalies or additional otologic disease (p = 0.01 and p < 0.01, respectively), but not across age groups (p = 0.65). Partial electrode insertion occurred in 17 cases. Electrode insertion and complication rates were comparable between groups (p = 0.08 and p = 0.99, respectively). Bony cochleostomy was significantly more common in the alternative methods group (p = 0.01). Conclusions: Inner ear anomalies and additional otologic diseases may necessitate alternative CI techniques. These methods achieve electrode insertion and complication rates comparable to standard approaches, supporting their effectiveness in selected cases. Full article

(This article belongs to the Special Issue The Challenges and Prospects in Cochlear Implantation)

17 pages, 1658 KB

Open AccessArticle

Longitudinal Cochlear Implant Outcomes in Danish Adults: Changes in Speech Recognition, Self-Reported Hearing Ability, Hearing-Related Quality of Life, and Tinnitus

by Line Husted Baungaard, Matilde Grønborg Sandvej, Mathilde Marie Overmark Nellemose, Marianne Kyhne Hestbæk, Louise Brasen Brændgaard, Mie Stenner Hansen, Mie Lærkegård Jørgensen, Per Cayé-Thomasen and Lone Percy-Smith

J. Clin. Med. 2025, 14(17), 6124; https://doi.org/10.3390/jcm14176124 - 29 Aug 2025

Cited by 1 | Viewed by 1207

Abstract

Background: This study assessed the efficacy and effectiveness of cochlear implants (CIs) by examining changes in speech recognition, self-reported hearing ability, hearing-related quality of life, and tinnitus over two years. Methods: A prospective two-year longitudinal study included 50 adult users of CI. Speech recognition in quiet and background noise was measured using Dantale I (with/without visual cues; fixed 0 dB SNR) and the adaptive Hearing in Noise Test (HINT). Self-reported outcomes were obtained using the Speech, Spatial, and Qualities of Hearing Scale (SSQ-12), Nijmegen Cochlear Implant Questionnaire (NCIQ), and Tinnitus Handicap Inventory (THI). Results: In post-lingually deafened users of CI (

N = 46

), Dantale with visual cues improved from 74.2% to 94.9% (mean difference = 20.7% [95% CI: 15.8, 25.6],

p < 0.001

d_{z} = 1.83

), and without visual cues from 58.9% to 92.1% (33.1% [28.0, 38.2],

p < 0.001

d_{z} = 2.83

). Dantale with background noise improved from 23.4% to 61.7% (37.6% [32.4, 42.8],

p < 0.001

d_{z} = 3.13

), and adaptive HINT from 8.6 to 4.2 dB SNR (

- 5.8

[−7.0, −4.6],

p < 0.001

d_{z} = 3.10

). NCIQ scores increased from 292.6 to 436.3 points (145.3 [122.8, 167.8],

p < 0.001

d_{z} = 3.11

), and SSQ-12 improved by 0.60 points [0.18, 1.02] from 1 to 2 years (

p = 0.015

d_{z} = 0.86

). Tinnitus severity remained low at the group level, with individual fluctuations over time. Conclusions: Danish adult users of CI showed substantial and sustained improvements in speech recognition and hearing-related quality of life over two years, with adaptive speech-in-noise testing proving particularly sensitive for detecting long-term changes. Full article

(This article belongs to the Special Issue The Challenges and Prospects in Cochlear Implantation)

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17 pages, 1351 KB

Open AccessArticle

Automated Speech Intelligibility Assessment Using AI-Based Transcription in Children with Cochlear Implants, Hearing Aids, and Normal Hearing

by Vicky W. Zhang, Arun Sebastian and Jessica J. M. Monaghan

J. Clin. Med. 2025, 14(15), 5280; https://doi.org/10.3390/jcm14155280 - 25 Jul 2025

Viewed by 1762

Abstract

Background/Objectives: Speech intelligibility (SI) is a key indicator of spoken language development, especially for children with hearing loss, as it directly impacts communication and social engagement. However, due to logistical and methodological challenges, SI assessment is often underutilised in clinical practice. This study aimed to evaluate the accuracy and consistency of an artificial intelligence (AI)-based transcription model in assessing SI in young children with cochlear implants (CI), hearing aids (HA), or normal hearing (NH), in comparison to naïve human listeners. Methods: A total of 580 speech samples from 58 five-year-old children were transcribed by three naïve listeners and the AI model. Word-level transcription accuracy was evaluated using Bland–Altman plots, intraclass correlation coefficients (ICCs), and word error rate (WER) metrics. Performance was compared across the CI, HA, and NH groups. Results: The AI model demonstrated high consistency with naïve listeners across all groups. Bland–Altman analyses revealed minimal bias, with fewer than 6% of sentences falling outside the 95% limits of agreement. ICC values exceeded 0.9 in all groups, with particularly strong agreement in the NH and CI groups (ICCs > 0.95). WER results further confirmed this alignment and indicated that children with CIs showed better SI performance than those using HAs. Conclusions: The AI-based method offers a reliable and objective solution for SI assessment in young children. Its agreement with human performance supports its integration into clinical and home environments for early intervention and ongoing monitoring of speech development in children with hearing loss. Full article

(This article belongs to the Special Issue The Challenges and Prospects in Cochlear Implantation)

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25 pages, 3131 KB

Open AccessArticle

Evaluating the Clinical- and Cost-Effectiveness of Cochlear Implant Sound Processor Upgrades in Older Adults: Outcomes from a Large Australian Multicenter Study

by Paola Vittoria Incerti, Jermy Pang, Jason Gavrilis, Vicky W. Zhang, Jessica Tsiolkas, Rajan Sharma, Elizabeth Seil, Antonio Ahumada-Canale, Bonny Parkinson and Padraig Thomas Kitterick

J. Clin. Med. 2025, 14(11), 3765; https://doi.org/10.3390/jcm14113765 - 28 May 2025

Cited by 2 | Viewed by 3568

Abstract

Background: Many older Australian adults with cochlear implants (CI) lack funding for replacement sound processors, risking complete device failure and reduced quality of life. The need for replacement CI devices for individuals with obsolete sound processors and no access to funding poses an increasing public health challenge in Australia and worldwide. We aimed to investigate the clinical and cost-effectiveness of upgrading obsolete CI sound processors in older adults. Methods: Alongside an Australian Government-funded upgrade program, a prospective, mixed-methodology design study was undertaken. Participants were aged 65 and over, with obsolete Cochlear™ sound processors and no funding for replacements. This study compared speech perception in noise, as well as self-reported outcome measures, including cognition, listening effort, fatigue, device benefit, mental well-being, participation, empowerment and user experiences, between upgraded and obsolete hearing aid processors. The economic impact of the upgrade was evaluated using two state-transition microsimulation models of adults using CIs. Results: The multi-site study ran from 20 May 2021 to 21 April 2023, with recruitment from June 2021 to May 2022. A total of 340 Cochlear™ sound processors were upgraded in 304 adults. The adults’ mean age was 77.4 years (SD 6.6), and 48.5% were female. Hearing loss onset occurred on average at 30 years (SD 21.0), with 12 years (SD 6.2) of CI use. The outcomes show significant improvements in speech understanding in noise and reduced communication difficulties, self-reported listening effort and fatigue. Semi-structured interviews have revealed that upgrades alleviated the anxiety and fear of sudden processor failure. Health economic analysis found that the cost-effectiveness of upgrades stemmed from preventing device failures, rather than from access to newer technology features. Conclusions: Our study identified significant clinical and self-reported benefits from upgrading Cochlear™ sound processors. Economic value came from avoiding scenarios where a total failure of device renders its user unable to access sound. The evidence gathered can be used to inform policy on CI processor upgrades for older adults. Full article

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12 pages, 964 KB

Open AccessArticle

A Machine Learning Model to Predict Postoperative Speech Recognition Outcomes in Cochlear Implant Recipients: Development, Validation, and Comparison with Expert Clinical Judgment

by Alexey Demyanchuk, Eugen Kludt, Thomas Lenarz and Andreas Büchner

J. Clin. Med. 2025, 14(11), 3625; https://doi.org/10.3390/jcm14113625 - 22 May 2025

Cited by 3 | Viewed by 1446

Abstract

Background/Objectives: Cochlear implantation (CI) significantly enhances speech perception and quality of life in patients with severe-to-profound sensorineural hearing loss, yet outcomes vary substantially. Accurate preoperative prediction of CI outcomes remains challenging. This study aimed to develop and validate a machine learning model predicting postoperative speech recognition using a large, single-center dataset. Additionally, we compared model performance with expert clinical predictions to evaluate potential clinical utility. Methods: We retrospectively analyzed data from 2571 adult patients with postlingual hearing loss who received their cochlear implant between 2000 and 2022 at Hannover Medical School, Germany. A decision tree regression model was trained to predict monosyllabic (MS) word recognition score one to two years post-implantation using preoperative clinical variables (age, duration of deafness, preoperative MS score, pure tone average, onset type, and contralateral implantation status). Model evaluation was performed using a random data split (10%), a chronological future cohort (patients implanted after 2020), and a subset where experienced audiologists predicted outcomes for comparison. Results: The model achieved a mean absolute error (MAE) of 17.3% on the random test set and 17.8% on the chronological test set, demonstrating robust predictive performance over time. Compared to expert audiologist predictions, the model showed similar accuracy (MAE: 19.1% for the model vs. 18.9% for experts), suggesting comparable effectiveness. Conclusions: Our machine learning model reliably predicts postoperative speech outcomes and matches expert clinical predictions, highlighting its potential for supporting clinical decision-making. Future research should include external validation and prospective trials to further confirm clinical applicability. Full article

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11 pages, 858 KB

Open AccessArticle

Utilization of the Spanish Bisyllable Word Recognition Test to Assess Cochlear Implant Performance Trajectory

by Meredith A. Holcomb, Erin Williams, Sandra Prentiss, Chrisanda M. Sanchez, Molly R. Smeal, Tina Stern, Amanda K. Tolen, Sandra Velandia and Jennifer Coto

J. Clin. Med. 2025, 14(3), 774; https://doi.org/10.3390/jcm14030774 - 24 Jan 2025

Cited by 1 | Viewed by 1296

Abstract

Objectives: The aims of this study were to compare pre- and post-operative word recognition scores (WRSs) for the adult Spanish-speaking population and to describe their cochlear implant (CI) performance trajectory. Methods: A retrospective chart review (n = 115) was completed for Spanish-speaking post-lingually deafened adults who underwent a traditional CI evaluation and subsequent surgery between 2018 and 2023. Pre- and post-CI (3, 6, 12-month) Spanish Bisyllable WRSs and CI datalogging (hours per day) were collected for 66 subjects who met inclusion. Patients were, on average, 61.4 years of age (SD = 14.9) at the time of their first CI, and all were Hispanic and White (100%). Results: The outcomes of the 66 subjects who met the inclusion criteria were analyzed. Spanish Bisyllable WRSs improved at all post-CI test intervals, though the mean change between intervals showed a decreasing trend over time, with a plateau in WRSs occurring by 6 months post-CI. Time was a significant predictor of increased post-CI WRSs at 6 months (p = 0.004) and 12 months (p < 0.001). Sex, the implanted ear, electrode type, CI manufacturer, and datalogging hours did not significantly predict Bisyllable WRSs. Conclusions: This study used the largest cohort dataset to date to describe pre-and post-CI WRSs for Spanish-speaking adults. The post-CI performance trajectory is similar in Spanish-speaking CI recipients compared to English-speaking cohorts. This study is fundamental in providing evidence-based outcomes for Spanish-speaking CI recipients and will assist clinicians with pre-CI counseling based on realistic expectations. Full article

(This article belongs to the Special Issue The Challenges and Prospects in Cochlear Implantation)

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28 pages, 1026 KB

Open AccessReview

Neuropsychological Assessments to Explore the Cognitive Impact of Cochlear Implants: A Scoping Review

by Brenda Villarreal-Garza and María Amparo Callejón-Leblic

J. Clin. Med. 2025, 14(21), 7628; https://doi.org/10.3390/jcm14217628 - 27 Oct 2025

Viewed by 1029

Abstract

Background/Objectives: Hearing loss constitutes a modifiable risk factor for dementia. Auditory rehabilitation with devices such as cochlear implants (CIs) has been reported to prevent cognitive decline in older adults. However, post-implant cognitive effects remain highly heterogeneous across studies. Thus, the aim of this review is to synthesize the evidence on cognitive outcomes and their interplay with speech perception, quality of life (QoL), and psychological status. Methods: A bibliographic search was conducted following PRISMA guidelines from January 2015 to July 2025. Studies were eligible if they included adult CI candidates who completed cognitive and audiometric assessments. In total, 43 studies, including longitudinal and cross-sectional designs, were reviewed. Several studies also assessed hearing aid (HA) users and normal-hearing (NH) controls. Principal results were identified and analyzed across cognitive domains, audiological performance, QoL, and psychological outcomes. Results: CIs significantly improved cognition across longitudinal studies, with a higher number of assessments reporting gains in memory (61%), global cognition (57%), and executive function (46%); while attention, language, and visuospatial skills were less frequently evaluated. Though findings are not fully consistent, interactions between speech intelligibility and cognitive subdomains have also been found in several studies: global cognition (25%), executive function (22%), visuospatial skills (20%), attention (21%), language (17%), and memory (12%). Improvements in QoL, social engagement, depression, and anxiety are frequently observed. Conclusions: The lack of unified and adapted neurocognitive tools may prevent the observation of consistent outcomes across studies. Further research and multimodal data are still needed to fully understand the interaction between cognition, speech intelligibility, and QoL in CI users. Full article

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Open AccessPerspective

Integrating Computational Modelling into the Ecosystem of Cochlear Implantation: Advancing Access to Diagnostics, Decision-Making, and Post-Implantation Outcomes on a Global Scale

by Tania Hanekom

J. Clin. Med. 2025, 14(22), 7929; https://doi.org/10.3390/jcm14227929 - 8 Nov 2025

Viewed by 464

Abstract

Disabling hearing loss affects more than 5% of the global population, with numbers expected to double by 2050. The burden is especially high in low- and middle-income countries, where access to cochlear implant (CI) technology and the required follow-up care is limited. While CIs are a proven treatment for certain types of hearing loss, their adoption in these countries is hindered by high costs, the need for specialised rehabilitation, and the financial and time commitment required for long-term device maintenance. Although remote programming has improved accessibility to standard care, specialised interventions for complications remain restricted mainly to areas with clinical centres. Computational modelling offers a promising solution to this access-to-care dilemma. The models may be used to simulate complications, such as non-auditory stimulation (NAS), to investigate and plan personalised interventions, and ultimately predict device parameters, without requiring the recipient’s physical presence. Both phenomenological and biophysical models have already demonstrated useful application in CIs: the former streamlines clinical workflows and aims to establish consistency in device fitting, and the latter provides insights into patient-specific auditory biophysiology. Despite decades of research, clinical translation of biophysical models has been limited by data constraints, parameter uncertainty, and validation challenges. In this perspective piece, it is argued that biophysical models have now reached sufficient maturity to be integrated into routine CI care. Apart from the advantages that this approach will bring to the overall advancement of person-centred CI care, it is envisioned to improve accessibility, personalisation, and long-term outcomes for CI recipients in low- and middle-income countries. Full article

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